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Cost-effectiveness of screening and optimal management for diabetes, hypertension, and chronic kidney disease: A modeled analysis

Howard, Kristen, White, Sarah, Salkeld, Glenn, McDonald, Stephen, Craig, Jonathan C., Chadban, Steven and Cass, Alan (2010). Cost-effectiveness of screening and optimal management for diabetes, hypertension, and chronic kidney disease: A modeled analysis. Value in Health,13(2):196-208.

Document type: Journal Article

IRMA ID 84473293xPUB39
Title Cost-effectiveness of screening and optimal management for diabetes, hypertension, and chronic kidney disease: A modeled analysis
Author Howard, Kristen
White, Sarah
Salkeld, Glenn
McDonald, Stephen
Craig, Jonathan C.
Chadban, Steven
Cass, Alan
Journal Name Value in Health
Publication Date 2010
Volume Number 13
Issue Number 2
ISSN 1098-3015   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-77149136720
Start Page 196
End Page 208
Total Pages 12
Place of Publication United States
Publisher Elsevier Inc.
HERDC Category C1 - Journal Article (DIISR)
Abstract OBJECTIVES: Chronic kidney disease is, increasingly, both a contributor to premature deaths and a financial burden to the health system, and is estimated to affect between 10% and 15% of the adult population in Western countries. Hypertension and, in particular diabetes, are significant contributors to the global burden of chronic kidney disease. Although it might increase costs, screening for, and improved management of, persons at increased risk of progressive kidney disease could improve health outcomes. We therefore sought to estimate the costs and health outcomes of alternative strategies to prevent end-stage kidney disease, compared with usual care.

METHODS: A Markov model comparing: 1) intensive management versus usual care for patients with suboptimally managed diabetes and hypertension; and 2) screening for and intensive treatment of diabetes, hypertension, and proteinuria versus usual care was developed. Intervention effectiveness was based on published meta-analyses and randomized controlled trial data; costs were measured from a central health-care funder perspective in 2008 Australian dollars ($A), and outcomes were reported in quality-adjusted life-years (QALYs).

RESULTS: Intensive treatment of inadequately controlled diabetes was both less costly (an average lifetime saving of $A133) and more effective (with an additional 0.075 QALYs per patients) than conventional management. Intensive management of hypertension had an incremental cost-effectiveness ratio (ICER) $A2588 per QALY gained. Treating all known diabetics with angiotensin-converting enzyme (ACE) inhibitors was both less costly (an average lifetime saving of $A825 per patient) and more effective than current treatment (resulting in 0.124 additional QALYs per patient). Primary care screening for 50- to 69-year-olds plus intensive treatment of diabetes had an ICER of $A13,781 per QALY gained. Primary care screening for hypertension (between ages 50 and 69 years) plus intensive blood pressure management had an ICER of $A491 per QALY gained. Primary care screening for proteinuria (between ages 50 and 69 years) combined with prescription of an ACE inhibitor for all persons showing proteinuria and all known diabetics had an ICER of $A4793 per QALY gained.

CONCLUSIONS: Strategies combining primary care screening of 50- to 69-year-olds for proteinuria, diabetes, and hypertension followed by the routine use of ACE inhibitors, and optimal treatment of diabetes and hypertension, respectively, have the potential to reduce death and end-stage kidney disease and are likely to represent good value for money.
DOI http://dx.doi.org/10.1111/j.1524-4733.2009.00668.x   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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